renal plasma flow - 625 ml / min
glomerular capillary pressure - 45 mmhg
peri tubular capillary pressure - 8 mmhg
pressure in renal vein - 4 mmhg
cortical blood flow - 5 ml per gm of kidney tissue per minute
medullary blood flow- outer 2.5 ml
Inner 0.6 ml
AV oxygen difference - 14 ml / l blood
po2 cortex - 50 mmhg
po2 medulla - 15 mmhg
👫PUBERTAL DEVELOPMENT👫
📌 DEVELOPMENT OF 2° SEXUAL CHARACTERS:
👩 In Females:
✔ T (Thelarche) ➡ P (Pubarche) ➡ M (Menarche)
▶ Thelarche - Breast enlargement
▶ Pubarche - Development of pubic hair
▶ Menarche - Onset of menstrual cycles
👨 In Males:
✔ T (Thelarche) ➡ P (Pubarche) ➡ A (Adrenarche)
▶ Thelarche - Testicular enlargement
▶ Pubarche - Penile enlargement
▶ Adrenarche - Features of maleness
📌 TANNER STAGING OF THELARCHE IN FEMALES:
🔰 Stage 1 - prepubertal elevation of papilla only
🔰 Stage 2 - elavation of breast tissue & papilla as a small mound, enlagement of areola
🔰 Stage 3 - further enlargement of breast & areola
🔰 Stage 4 - projection of areola & papilla to form a secondary mound
🔰 Stage 5 - secondary mound disappears, adult breast with typical contours develops
📌 STAGING OF PUBARCHE IN FEMALES:
🔰 Stage 1 - no sexually stimulated pubic hair present, some non-sexual hair maybe seen in the genital area
🔰 Stage 2 - appearance of coarse, long, crinkly hair along labia majora
🔰 Stage 3 - coarse, curly hair extending onto mons pubis
🔰 Stage 4 - adult hair in thickness & texture, extending laterally onto mons pubis giving the vulva an inverted triangular appearance
🔰 Stage 5 - hair may extend further laterally onto inner aspects of thighs & perineum
👉 Axillary hair appears a little later in sequence.
👉 Secondary hair growth is under control of adrenal cortex.
📌 SEXUAL MATURITY RATING (SMR):
👩 In females:
💃 Stage 1 -
● prepubertal,
● no terminal hair
💃 Stage 2 -
● appearance of breast bud;
● sparse straight hair along the labia majora
💃 Stage 3 -
● generalised breast enlargement (extending beyond the areola);
● pigmented, coarse pubic hair, begins to curl
💃 Stage 4 -
● nipple & areola form a second mound over breast;
● hair increases in amount & spread over entire mons
💃 Stage 5 -
● mature adult type breast, nipple projects & areola recedes;
● adult type pubic hair in triangle shaped area, spreading over to medial thighs
👨 In males:
🏃 Stage 1 -
● testicular size <2.5cm, vol. <3ml;
● prepubertal
🏃 Stage 2 -
● testicular size 2.5-3.2cm, vol. reaching 4ml, reddening of scrotum;
● scanty hair at penile base
🏃 Stage 3 -
● testicular size 3.3-4.0cm, further increase in vol. to 10ml
● increase in length of penile shaft
● hair begins to curl & darken
🏃 Stage 4 -
● testicular size 4.1-4.5cm, vol. 16ml
● increase in girth of penis & glans, darkening of scrotum
● coarse, abundant & curly hair, less than in adult
🏃 Stage 5 -
● testicular size >4.5cm, vol. 25ml
● adult size scrotum & penis
● adult type hair, spreading over to medial thighs
📚 References:
📖 Shaw's TB of Gynaecology, 15th Edition
📖 Ghai Essential Pediatrics, 8th Edition
Mineral Stored With Insulin In Beta Cell Granules :- Zinc
Mineral Which Increases Insulin Sensitivity And Alleviates Insulin Resistance :- Chromium
One Gram Of Insulin Neutralizes 2.5 Grams Of Glucose
Insulin Works By
Tyrosine Kinase Receptor Pathway
Fetal Hyperinsulinemia Due To Maternal Hyperglycemia Is Called -" Pederson Hypothesis"
Discovered By Banting And Best
Chemical Structure Given By -" Sanger"
Only Insulin Sensitive Area Of Brain Is -" Satietary Centre / Venteromedial Nucleus Of Hypothalamus
Insulin Secretion Begins At 11-12 Weeks Of Intrauterine Life
Anti-Arrhythmics:
Ia: PDQ: Procainamide, Diisopyramide,
Quinidine
Ib: MeLT: Mexiletine, Lidocaine, Tocainaide
Ic: PrEF: Propafenone, Flecainide, Encainide
III: DIBS: Dofetilide, Ibutilide, Bretylium,
Sotalol.
🍍ANTLER LIKE/STAG HORN APPEARANCE- downling degos disease
🍍BOX SHAPED/SQUARED OFF APPEARANCE- indurative stage of morphea/localised scleroderma
🍍BUSY DERMIS APPEARANCE- histiocytoma
🐪CAMEL FOOT APPEARANCE/ACANTHOSIS-plaque type psoriasis
🏀CANNON BALL APPEARANCE-angioblastoma
🍗CHICKEN WIRE/🐠FISH NET PATTERN-p.vulgaris
🍍CHURCH SPIRE APPEARANCE-hyperkeratotic seborrheic keratosis
🍍CLAW CLUTCHING BALL APPEARANCE-lichen nitidus
🍍CLOCK FACE/CART WHEEL-plasma cell
🍍COAT SLEEVE APPEARANCE- primary and secondary lesions of syphilis
🍍CRIBRIFORM APPEARANCE-trichoepithelioma
🍍DILAPIDATED BRICK WALL-hailey hailey disease
🍍FESTOONED PAPILLAE-prorphyria cutaneous tarda
🍍FLAME THROWER LIKE-vertical section of telogen hair shaft
🍳FRIED EGG-mastocystosis,neurofibroma
🍍JIG SAW PUZZLE-cylindroma
🍍MARINERS PILOT WHEEL-brazilian blastomycosis
🍍MORULA LIKE-protothecosis
🔮ONION SKIN LIKE-pacinian corpuscle
👀OWLS EYE APPEARANCE-verucca plana
🎨PAINT BRUSH LIKE-penicilium marneffei
🍍PALISADING APPEARANCE-BCC
🍍PICKET FENCE APPEARNACE-dermatitis herpetiformis
🍍RAVELLED WOOL-pseudoxanthoma elasticum
🍍SAFETY PIN-donovanosis
🍍SAW TOOTH APPEARANCE-lichen planus
🍅SEPTATE TOMATO APPEARANCE-molluscum contagiosum
🍍SIEVE LIKE-kaposis
🍖SPAGHETTI AND MEAT BALL/🍌BANANA $🍇GRAPE LIKR-pitryasis versicolor
🍍STORIFORM-dermatofibrosarvoma protuberance
🍍SWARM OF BEES-alopecia areata
🍣SWISS CHEESE-sclerosing lipogranuloma
🍍TADPOLE/COMMO SHAPED-syringoma
📞TELEPHONE HANDLE-deep nucleus of eosinophil
🍍TISSUE CULTURE LIKE-nodular fascitis
🍍TOMB STONE-p.vulgaris
🍍TRILAYERED/STRIPED-lichen sclerosis
🍍WIND BLOWN-bowens disease
mnemonic for porphyria👉
Mnemonic for the Hereditary porphyrias...
All---------------Acute Intermittent Porphyria
Congenital------Congenital erythropoetic Porphyria
Porphyrias------Porphyria Cutanea Tarda
Have------------Hereditary Coprophyria
Variable---------Variegate Porphyria
Presentation----Protoporhyria
Now all u got to do is memorize the pathway......
the first enzyme.....ALA synthase and ALA dehydrase have no deficincies that i know of and even if they did then they wldn't cause porphyria.....
then you got the next enzyme
Uroprophyrinogen I synthase..............Acute I.Porphyra
Uroporphyrinogen III co-synthase.......Congenital erythropoetic Porphyria
Uroporphyrinogen III decarboxylase....Porphyria Cutanea Tarda
Coprophyrinogen III oxidase...............Hereditary Coprophyria
Protoporhyrinogen oxidase.................Variegate Porphyria
Ferrochelatase....................................Protoporhyria
Orthopaedic imp II
From newer edition f maheshwari
-inferior capsule is weakest portion of shoulder joint
-tests for anterior glenohumeral instability are apprehension test,fulcrum test,crank test,jobe's relocation test and surprise test
-test for posterior glenohumeral instability is jerk test
-sulcus test done for multi-directional and inferior stability
-lift off test evaluates subscapularis muscle activity.
-anconeus triangle formed by radial head,lateral epicondyle, and tip of olecranon
-mc cause f volkman's ischaemic contracture (VIC) in a child is supracondylar fracture f humerus n mc muscle involved in VIC is flexor digitorum profundus
-head f radius excision leads to valgus deformity at elbow.
-fracture of both bones f forearm abv insertion of pronator teres is immobilised in supination below insertion of pronator teres is immobilised in mid-neutral position.
-the proximal fragment of scaphoid fracture is more prone to avascular necrosis due to retrograde blood blow to proximal fragment
-lunate dislocation cn lead to medial nerve injury.
-incidence f injury in carpal bones is scaphoid>triquentral>trapezium>lunate.
-bennett:'s fracture is difficult to maintain in a reduced position due to pull of abductor pollicis longus.
-skiers thumb/gamekeepers thumb is n injury to ulnar collateral ligament of the metacarpo-pharyngeal joint.it is injured during skiing,holding a catch and twisting the neck of small animals.an incomplete rupture is treated conservatively with a thumbs spica or functional cast brace.a complete rupture is treated by surgical repair
-stener lesion occurs whn the adductor pollicis aponeurosis becomes interposed BTW the retracted ligament and this hinders healing.
-in pelvis fracture blood loss is 4-8units.
-jumpers fracture is a type f pelvic fracture
-kocher langenbeck approach is for posterior caudal exposure
-ilioinguinal approach is for internal or anterior approach.
-extended iliofemoral approach is to expose both the anterior and posterior columns.
-main blood supply to head f femur in adults is the lateral ascending cervical or retinacular and epiphyseal branches f medial circumflex femoral artery
-the commonest hip injury in the elderly patient is intertrochanteric (extra capsular fractures)
-occult fracture neck f femur best diagnosed by MRI
-maximum chances f avascular necrosis is subcapital fracture.
-fracture head f femur classified by Pipkin classification.
-femoral head palpable on per rectal examination in central dislocation f hip.
-paralysisf gluteus medius/minimus supplied by superior gluteal nerve causes trendelenburgs gait.
-upper 1/3rd shaft f femur mc fracture at birth
-maximum shortening f lower limb is seen in fracture shaft f femur and posterior dislocation f hip.
-in 90° flexion f knee the tibial tuberosity is in line with centre f patella on extension it moves towards the lateral border due to screw home mechanism
-people with anterior cruciate deficient knees have problem climbing downhill.
-dial test,tests posterolateral corner and positive cruciate ligaments
1)posterolateral corner deficiency positive at 30° flexion.
2)posterior cruciate ligament positive at both 30° and 90° flexion.
-physiological locking occurs with internal rotation f femur over fixed tibia by the quadriceps,unlocking refers to lateral rotation f femur over a stabilized tibia by the popliteus
-rotation force is most imp in causing meniscal injury.
